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目的:探讨西地那非治疗高原地区先天性心脏病(CHD)合并重度肺动脉高压(SPH)患儿的临床疗效和安全性。方法:选择2010年1月~2013年10月青海省妇女儿童医院连续转入重症监护病房的CHD合并SPH患儿50例,将患儿随机分为研究组(25例)和对照组(25例),对照组给予常规方法治疗,研究组在此基础上口服西地那非,分析两组患儿治疗前后血流动力学、血气、血常规和血生化指标变化情况。结果:研究组患儿治疗后平均肺动脉压(PAP)的下降程度,动脉血氧分压(Pa O2)、心输出量(CO)、心脏指数(CI)及氧合指数(OI)的上升程度均明显优于对照组,两组比较,差异有统计学意义(P<0.05)。研究组平均体动脉压(SAP)、血常规、血生化指标均无明显变化,差异无统计学意义(P>0.05),无明显不良反应发生。结论:西地那非能有效降低高原地区CHD合并SPH患儿的PAP,改善患儿的心功能。对创造安全手术条件、降低手术风险具有重要的意义。
Objective: To investigate the clinical efficacy and safety of sildenafil in the treatment of children with congenital heart disease (CHD) complicated with severe pulmonary hypertension (SPH) in the plateau. Methods: From January 2010 to October 2013, 50 children with CHD and SPH in Qinghai Women and Children’s Hospital were enrolled in the intensive care unit. The children were randomly divided into study group (25 cases) and control group (25 cases) ). The control group was given routine treatment. On the basis of that, the study group was given sildenafil orally, and the changes of hemodynamics, blood gas, blood and blood biochemical indexes before and after treatment were analyzed. Results: The decrease of average pulmonary arterial pressure (PAP), the increase of Pa O2, CO, CI and OI in the study group after treatment Were significantly better than the control group, the difference between the two groups was statistically significant (P <0.05). There was no significant difference in mean arterial pressure (SAP), blood routine and blood biochemistry between the two groups (P> 0.05). No adverse reactions were found. Conclusion: Sildenafil can effectively reduce PAP in children with CHD and SPH in the plateau area and improve heart function in children. The creation of safe surgical conditions, reduce the risk of surgery is of great significance.